Urinary incontinence

“ For the serosities, which are secreted by the kidneys (whose cavity is even at this day named pelvis by Anatomists) runs into the bladder; which, by reason of the relaxation of its sphincter, as if the pitcher were broken at the fountain head, is not able to retain its contents a sufficient time. Hence an incontinence or dribbling of urine is continually troublesome.
Now, the evils hitherto enumerated lodge in particular parts; but the last calamity, both in this discourse, as well as in old people, is that the whole body is afflicted. The very course of the blood is interrupted ”

“ If the bed clothes are not found wet after a full dose of opium, during the operation of which the patient has been suddenly awoke, we may also be satisfied that there is no incontinence. Foderé says that if the penis is secured by a ligature, it will swell considerably in the real incontinence, in consequence of the urine running into the urethra; but that no such effect will happen if the disease be feigned. ”

“ Where the inconvenience thus detailed is present, the quantity of fluids must by degrees be diminished, the general state of health must be studied. Dieting and warm-bathing are two sheet-anchors, if properly applied. All remedies tending to afford strength to the urinary system must be had recourse to; and where the bladder loses any of its retentive power, I entertain the greatest benefit from an injection.
The next form of urinary disturbance of a proximate nature to the one just described, is also where the urine is discharged in large quantities ”

“ The symptoms of pressure are very marked in the case of intra-ligamentous tumors. The capacity of the bladder may be so diminished that there may be continuous incontinence of urine; or the bladder and the urethra may be so distorted, from traction and pressure, that urine is voided with great difficulty, and it is sometimes impossible to introduce the catheter. I have seen a woman with a fibroid the size of the adult head who could urinate only when upon her hands and knees. ”

“ The intestines next to the stomach are the most often sympathetically affected in diseases. The bladder is the organic muscle that is the last to feel the influences that go from the diseased organ; this sometimes however happens. In fevers, we know that retentions of urine from sympathetic and temporary paralysis, are not very rare; incontinence of urine is less often seen. ”

“ In such cases the bladder often attains a very large size. At first the accumulation produces all the uneasy symptoms formerly mentioned, but after some time these subside, and the urine drains away according as it is secreted, without, however, the original accumulation and tumour being diminished. This state of the urinary system is very common in old people, who neglect natural calls to empty the viscus during the night, or while sitting socially after dinner. The uneasiness gradually goes off, and when they at length think of making water, none can be got to flow. ”

“ It may follow an obstruction from disease, to which is added temporary swelling and nervous contraction of some part of the urinary passage; or it may be due to spasm and closure of the outlet from nervous irritation, as in the cases of injuries and surgical operations in the vicinity of the sexual organs, the rectum, or in other parts of the body. Overdistention of the bladder from failure to pass water for a long time may lead to a condition where urination becomes an impossibility. ”

“ It is very rapid and dangerous: total suppression within a very few days excites burning fever, lethargy, delirium, convulsions, gangrene: or even after recovery from a violent disease, incontinence of urine may remain for a considerable time.
Of calculus, or stone in the bladder, the symptoms are all dubious, without sounding the bladder with the surgical instrument. It is a chronic disease, slow in accumulation; and is frequently endured many years, without having recourse to lithotomy. The symptoms vary in severity, and recur in exacerbations{303} at uncertain intervals ”

“ The symptoms of urethral stricture in women are much less marked than those in men. There is frequent and difficult urination. Occasionally there is incontinence or partial retention of urine.
If the stricture exist at the external meatus, it may be readily seen and its dimensions determined. If it exist in the upper portion of the urethral canal, it may sometimes be felt by palpation along the course of the urethra through the vagina, the position of the stricture being indicated by local thickening and induration. ”

“ The lesion is exposed to continuous irritation from the urine and from the sphincteric action of the muscular fibers at the vesical neck—an action which is much increased by the tenesmus present. This constant muscular action impedes healing, as in the case of fissure of the anus. The internal urinary meatus should be dilated under anesthesia to the extent of 1⁄2 inch by means of the graduated bougies or the uterine dilator. After dilatation the woman should be kept in bed and the urine should be rendered as unirritating as possible by the use of diluent drinks and boracic acid. ”

“ An abundant flow of urine might perhaps carry off more rapidly such individuals as have found their way into the urinary passages, and, considering the character of the deposit described above as causing stoppage of the ureter, treatment directed against the uric-acid diathesis might diminish the risk of this particular form of trouble. ”

“ The enlargement of this lobe produces an effect which is not generally known, and leads medical practitioners into an error respecting the nature of the complaint. The orifice of the urinary bladder, which is the lowest part in the natural state, is raised up in proportion to the increase of this lobe; so that none of the contents below that level can be expelled, although whatever is above it is allowed with more or less difficulty to pass out. In this way the person never evacuates more than one half or one third of the urine contained in the bladder ”

“ Ultzmann, of Vienna, in his work on the “Neuroses of the Genito-Urinary Organs,” gives the subject of enuresis considerable attention. It is not a work on diseases of children, but it, nevertheless, goes into the subject as if it were, and furnishes the profession with considerable information. He defines enuresis to be the passage of urine of a normal quality in a child who, with the exception of this involuntary urination, is healthy. In the first periods of life, a slight vesical or intestinal expulsive effort is sufficient to overcome the guarding sphincter muscles at their outlet ”

“ Many females can urinate with tolerable comfort while lying on the back or abdomen, and others are much [402] relieved by constantly wearing a bandage. Constipation always makes this difficulty worse, and sometimes even causes it, by keeping the rectum full and thus increasing the pressure. In all such cases it will be readily seen, that forcing medicines are not only useless, but liable to cause injury. The change of position, rest, and supporting the abdomen are the means to be relied upon. If these fail, and the urine accumulates, the catheter must be used. ”

“ Some patients keep a catheter and "draw" their own urine. Unless the patient takes great care, the bladder and urethra will be irritated and perhaps infected through neglect of cleanliness. Medicines are not very useful in severe cases. Operation is the only reliable cure especially when some urine is always retained. ”

“ If she find an obstruction or stoppage of the urine, by reason of the womb's bearing too much on the bladder, let her lift up her belly a little with her hands, and try if by that she receives any benefit; if she finds she does not, it will be necessary to introduce a catheter into her bladder, and thereby draw forth her urine. If the difficulty be from the ill posture of the woman, let her be placed otherwise, in a posture more suitable and convenient for her ”

“ Actual retention of urine, that is, urinary secretion passed into the bladder, but retention in the latter viscus by inanition, stricture, or other obstruction, naturally cannot continue any great length of time without mechanically rupturing the vesical walls; but suppression of urine or absolute anuria may last an astonishingly extended period. Of the cases of retention of urine, Fereol mentions that of a man of forty-nine who suffered absolute retention of urine for eight days, caused by the obstruction of a uric acid calculus. ”

“ Unless a specialist of experience be consulted, the bladder will most probably be examined, and medicine will be prescribed only to excite the kidneys to secrete more urine, which does harm instead of good; the disease slowly, but surely progressing. Patients often write us that they have had something wrong with the bladder for a number of years, having to urinate more frequently than they ought ”

“ In many instances, too, the urinary passages are affected, the patient being harassed with frequent, painful and difficult micturition, swelling of the penis, and pain in the region of the bladder, or, if a female, 238with burning pain of the vagina and excoriation of the labia. [618] Sometimes the irritation of the urinary organs is so great as to be attended with total suppression of urine, as in a case related by Guilbert of Montpellier, in which this symptom continued several days. ”

“ On introducing the catheter sometimes part of the urine will come away and not the whole, which is difficult to explain; but may arise from the weakness of the muscular fibres of the bladder; which are not liable suddenly to contract themselves so far as to exclude the whole of the urine. In some old people, who have experienced a long retention of urine, the bladder never regains the power of completely emptying itself; and many who are beginning to be weak from age can make water a second time, a few minutes after they supposed they had emptied the bladder. ”

“ Follow this on the fourth day by a copious enema, one pint of water, to which one tea-spoon [Pg 233] of salt has been added. After three days, if the symptoms still continue, repeat treatment.
Incontinence of Urine.—This annoying ailment is common among children. Mothers and nurses often deal impatiently with the unfortunate child, believing it to be a habit, which may be easily overcome. It is more often a malady than a habit. In neither case is it ever cured by scolding. If a habit, a promised reward is more effective than harsh treatment. Give the child a light supper devoid of liquids. ”

“ Sometimes the detrusor is in a paretic condition. In paresis of the bladder the patient has to wait for the urine to come and has to use abdominal pressure to effect urination. The urine falls without force perpendicularly from the urethra. There is often desire to urinate, but never a feeling of satisfaction after urinating. When catheterization is attempted, there is a powerful resistance at the neck of the bladder, through a certain spasm of the sphincter. ”

“ Many patients find it difficult, even impossible, to void urine during the first several hours after delivery because of the removal of intra-abdominal pressure; the recumbent position and the swelling and bruised state of the tissues about the urethra. The bladder is likely to be less sensitive than usual and the patient will be able to retain an abnormally large amount of urine for several hours without discomfort, or desire to void. ”

“ When the part becomes morbidly enlarged, it acts as a mechanical impediment to the passage of urine from the bladder, but from this circumstance we cannot reasonably infer, that while of its normal healthy proportions, its special function is to facilitate the egress of the urine, for the female bladder, though wholly devoid of the prostate, performs its own function perfectly. ”

“ Stricture of the urethra, prostatic disease, and gravel, or stone in the bladder, are all capable of producing obstruction to the free flow of the urine.
How Slight Ailments become Dangerous Diseases. As we have before stated, the mucous membrane lining the bladder is reflected upwards into the ureters, lining these canals. By reason of this continuity of mucous surfaces, patients suffering from urethral, prostatic, and bladder affections, often die from disease of the kidneys. ”

“ On the other hand, a man may continue about and at his work with a patient flabby bladder containing constantly more or less stringy mucus and ammoniacal urine, suffering little or no pain or tenesmus, and perhaps having no subjective symptoms except a slight sense of weight in his lower belly and a rather frequent desire to urinate. ”

“ To sum up the results of my experience in the management of seminal incontinence, I may add that the steel bougie, bromide of potassium, and atropia are especially adapted to cases of nocturnal and diurnal pollutions, and that after the hyperæsthesia has been relieved electricity, ergot, and strychnia are the most reliable agents in spermorrhagia. The end having been accomplished, moderation in sexual intercourse should be enjoined if the patient is married; continence in thought and action should be observed if he remains single ”